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Canadian Journal of Anesthesia 49:701-705 (2002)
© Canadian Anesthesiologists' Society, 2002
Obstetrical and Pediatric Anesthesia

Plasma lidocaine concentrations are higher in twin compared to singleton newborns following epidural anesthesia for Cesarean delivery

[Les concentrations plasmatiques de lidocaïne sont plus élevées chez les nouveau-nés jumeaux, comparés au nouveau-né unique, à la suite d’une anesthésie épidurale pour césarienne]

Manuel C. Vallejo, MD and Sivam Ramanathan, MD

From the Department of Anesthesiology, Magee-Womens Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Address correspondence to: Dr. Manuel C. Vallejo, Department of Anesthesiology, Magee-Womens Hospital, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15213, USA. Phone: 412-641-4260; Fax: 412-641-4766; E-mail: vallejomc{at}anes.upmc.edu

Purpose: This study compares plasma lidocaine concentrations in 16-sets of twin neonates to 16-singleton neonates all of whom were delivered by Cesarean section under lumbar epidural anesthesia (LEA).

Methods: Lidocaine 1.5% with epinephrine 5 µg•mL-1 was used for activation of LEA. Upon delivery plasma lidocaine concentrations were measured from the maternal vein (MV), neonatal umbilical vein (UV) and umbilical artery (UA) using TDx fluorescence polarization immunoassay.

Results: MV lidocaine concentrations were similar in both twin and singleton mothers. Both mean lidocaine UV and UA levels were 35% higher in twin A (first-delivered) compared to the singleton neonate, (P < 0.01, t test). Similarly, twin B mean UV and UA lidocaine levels were 35% and 53% higher than the singleton value (P < 0.01). Mean UV and UA lidocaine fetal/maternal ratios in both twins were at least 18% higher than the singleton value (P < 0.05).

Conclusion: Even though there were no differences in neonatal outcome, a potential does exist for high plasma lidocaine concentrations in twin fetuses, suggesting that the total maternal dose of lidocaine must be regulated carefully.






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Copyright © 2002 by the Canadian Anesthesiologists' Society.